Training

STD/AIDS Research Training Fellowship Program

Public Health and Epidemiology Track

Laura A. Koutsky, PhD, MSPH, Anna Wald, MD, MPH - Co-Directors

Overview: The Epidemiology and Public Health track, developed in collaboration with the Department of Epidemiology, trains postdoctoral (MPH) and predoctoral (PhD) fellows for academic careers in STD and HIV research, teaching, and public health practice. The MPH component of the track fulfills the need for clinical and population-based epidemiologic methods training among trainees in this and other tracks; the PhD component provides talented predoctoral students training in both biomedical and methodological aspects of STD/HIV prevention research. There is no shortage of qualified candidates for this track. For the past several years, STD/HIV has been the number one interest among applicants to the graduate program in epidemiology. Last year, 34/68 (50%) enrolled students planned to pursue an STD/HIV-related research topic.

Trainees participate in the STD and AIDS Core Curriculum, and also in 1) course-work and dissertation/thesis leading to a PhD or MPH in epidemiology. The degree requirements are outlined in the Department of Epidemiology, program guidelines (http://depts.washington.edu/epidem/program.htm); 2) clinical, epidemiologic, and STD/HIV prevention research; and 3) preceptorships with faculty consultants in public health STD/HIV epidemiology and prevention programs.

Predoctoral students in epidemiology who have completed one year of course work, and have identified a dissertation project and a training faculty mentor, are eligible for this fellowship. Resumes of interested students are forwarded to the track co-directors to identify well-qualified and eligible candidates. The student’s STD/AIDS fellowship application is reviewed by the track directors. The student’s research committee, including one or more Epidemiology & Public Health Track faculty members, helps with the development of a formal research proposal (based on the NIH PHS 398 Research Plan), monitors the student’s progress twice yearly (making recommendations for additional course work if needed), and administers the qualifying exam and final defense. Three first-author publications in peer-reviewed journals are expected. Predoctoral students generally obtain the PhD within 4 to 5 years.

Postdoctoral MPH candidates also establish a thesis committee, write a research proposal and a thesis prepared for publication. Postdoctoral fellows usually receive 2 years of support on this training grant. They and their faculty mentors are expected to seek independent funding to support the third and subsequent years of training.

Didactic MPH/PhD Curriculum and additional seminar opportunities: There are multiple components to the curriculum: 1) All trainees participate in the STD and AIDS Core curriculum, and take 3-4 quarters of epidemiologic methods, 3 quarters of epidemiology seminar, and at least 1 quarter (MPH students) or 4-5 quarters (PhD students) of biostatistics. For postdoctoral trainees seeking an MPH in epidemiology, didactic courses occupy most of the first training year, with introductory/overview courses in the Summer quarter and formal courses attended October through June. Three courses, conducted jointly by the Departments of Medicine (Infectious Diseases), Epidemiology, and Biostatistics, were specifically developed for trainees in this track: HIV/AIDS: A Multidisciplinary Approach (EPI 530, 2 credit hours) also now taken by many trainees from other tracks; Principles of Epidemiology and Biostatistics for STD/HIV Research (UCONJ 555A, 2 credit hours); and Methodologic Issues in STD/HIV Research (UCONJ 555B, 2 credit hours). 2) All students prepare an NIH-style research proposal 3) Dissertation Research Seminar (EPI 584, 3 credit hours) is required for all PhD students. 4) Both pre- and post-doctoral trainees participate in Epidemiology Seminar (bi-weekly), Biostatistics Seminar (weekly), STD Journal Club and Seminar Series (monthly), HIV/AIDS Seminar Series (monthly), and the HPV Journal Club and Seminar Series (monthly). Trainees present results of their research at one of these meetings.

Faculty: 22 faculty members participate in the Epidemiology and Public Health Track, including 13 training faculty and 9 resource faculty members. Faculty and trainees in this track always work closely with those in other tracks, especially the International and Sociobehavioral Research tracks.

Research Training Opportunities: The UW graduate program in epidemiology teaches multidisciplinary approaches to the design and conduct of studies in diverse populations. STD & AIDS trainees have benefited enormously from learning how to work with scientists from other disciplines and with community-based organizations. A short synopsis of research of the training faculty is provided below:

• Koutsky, Laura, PhD Track Co-Director, Training Faculty Laura Koutsky’s research concerns the epidemiology of HPV and HPV-related cancers. Current projects include longitudinal studies of the acquisition and natural history of HPV infections in men and women, investigations into the accuracy, reliability, and cost-effectiveness of new strategies for the early detection of HPV-related cancers, and clinical trials of prophylactic HPV vaccines.
  
  
• Wald, Anna, MD, MPH Track Co-Director, Training Faculty Current research centers on the epidemiology and natural history of HSV infections in immunocompetent and immunocompromised hosts. Specific goals are to characterize the biology and epidemiology of HSV acquisition/ transmission; to develop strategies for prevention of HSV transmission to neonates at birth; to determine the immunogenetic predictors of HSV shedding; to understand relationships between HIV and HSV-2 infections; and to investigate protective immunity to HSV-2. These studies are conducted with Drs. Corey and Koelle. Additional studies investigate the epidemiology of HHV-8 infection, the risk of mucosal shedding of HHV-8 in HIV-and HIV+ populations, and the effect of HAART on HHV-8 shedding and progression to Kaposi’s sarcoma.
  
  
• Fleming, Tom, PhD Training Faculty Dr. Fleming interacts extensively with the Seattle AIDS research community as a biostatistical collaborator, consultant, and co-investigator. He is Director of the Biostatistics/Epidemiology Core of CFAR, working in close collaboration with the Associate Director, Dr. Hughes. He has worked locally and nationally with Dr. Corey, and has developed a collaborative relationship with Dr. William Lafferty, who is head of the clinical research program jointly coordinated by Washington State and the CDC. He has collaborated with Dr. John-Stewart on clinical research from the IATRP, and has served as chair of the DSMB of her major Phase III randomized trials evaluating the role of breast-feeding in perinatal HIV transmission and the microbicide nonoxynol-9 in sexual transmission.
  
  
• Golden, Matt MD, MPH Training Faculty Dr. Golden’s primary interest is in operational research evaluating new public health interventions to control of STD’s including HIV, conducted as a collaboration between UW and Seattle/King County Public Health and provides fellows a training opportunity that integrates research and public health practice. Ongoing projects include a community-level randomized trial of expedited partner therapy for gonorrhea and chlamydial infection and a trial designed as a preliminary evaluation of contingency management to decrease methamphetamine use and STD in HIV negative men who have sex with men (MSM). Additional projects focus on new approaches to HIV testing and counseling, screening and re-screening for gonorrhea and chlamydial infection, and diagnostic microbiology.
  
  
• Hawes, Stephen, PhD Junior Training Faculty Dr. Hawes has been involved in research concerning sexually transmitted diseases and HIV for over 15 years. His primary interests, with Dr. Kiviat, concern the interactions between STI and HIV. Dr. Hawes is examining the role of HIV, human papillomavirus (HPV) and other STI in the natural history of anal and cervical neoplasia in MSM in Seattle and in both men and women in Senegal, West Africa. He also examines factors associated with oral, anal, and vaginal shedding of HIV-1 and/or HIV-2. Finally, he studies biomarkers for detection and progression of precursor lesions, early detection, and prognosis of various cancers, including cancer of the cervix, anus, breast, lung, and skin.
  
  
• Hitti, Jane, MD Training Faculty Dr. Hitti’s interests include clinical, epidemiologic and translational research related to infections in pregnancy. She has investigated infectious and inflammatory correlates of preterm birth, neonatal outcomes after intrauterine exposure to infection and inflammation, and mechanisms related to racial disparities in preterm birth. She also has a major interest in the impact of HIV infection and antiretroviral therapy on maternal health, including pharmacokinetics, safety, efficacy and toxicities. She has investigated factors influencing HIV pathogenesis in the female genital tract.
  
  
• Holte, Sarah, PhD Junior Training Faculty Dr Holte’s research is focused on the development and analysis of mathematical models for biological processes involved in the etiology and pathogenesis of HIV/AIDS and other STD’s. This includes the development of statistical methods and study design for the analysis of data when the outcome of interest is a parameter in models of this type.
  
  
• Hughes, James, PhD Training Faculty Dr. Hughes is interested in the application of statistical methods to problems in AIDS and other sexually transmitted diseases. Methodologically, a particular interested is cluster randomized trial designs and statistical methods for dealing with misclassified data. Dr. Hughes is the lead statistician on the HPTN039 and PREVEN trials, as well as a trial of expedited partner treatment (in collaboration with Dr. Golden) being conducted in Washington state.
  
  
• Kitahata, Mari, MD, MPH Training Faculty Dr. Kitahata directs Health Services Research and Development for the HMC AIDS Program and the Center for AIDS Research at the University of Washington. She also directs HIV/AIDS research at the Center for Health Studies, Group Health Cooperative. Current research includes the effect of physicians’ experience with HIV disease on patient outcomes; caring for persons with HIV infection in a managed care environment; the effect of computerized interventions to promote evidence-based guidelines for antiretroviral therapy and the prevention of opportunistic infections through adherence to standards of HIV/AIDS care; patterns of service utilization and cost of HIV care; cost-effectiveness of treatment innovations; and models of health care delivery.
  
  
• Kurth, Ann, PhD Training Faculty Dr. Kurth is Associate Professor, Depts. of Biobehavioral Nursing and Health Systems and Global Health; and Adjunct Associate Professor, Epidemiology. Her research interests include health system and provider factors that influence individuals' HIV/STD risk, and specifically in developing tools to improve HIV/STD screening and prevention. Her current work in applied informatics and behavioral / clinical epidemiology evaluates provider counseling and computer, internet, and telephone-based approaches to HIV/STD testing, chronic disease self-management, and sexual health promotion in the US as well as in international settings.
  
  
• Manhart, Lisa, PhD Training Faculty Dr. Manhart’s research interests are in sexually transmitted infections (STI) and human immunodeficiency virus (HIV). Her current research involves defining the clinical epidemiology of two potentially new STI pathogens, Mycoplasma genitalium and Ureaplasmas, including interactions with HIV infection. In addition to an ongoing clinical trial of standard therapies for these new etiologies of non-gonococcal urethritis, she also studies sociobehavioral factors associated with STI, transmission dynamics, and epidemiologic methodology related to STI research. In population-based research she collaborates with the National Longitudinal Study of Adolescent Health on studies comparing this nationally representative survey to STD clinic-based populations. Internationally, Dr. Manhart collaborates with an epidemiology group in India on a monitoring and evaluation study of capacity to provide HIV-care in government facilities in the state of Andhra Pradesh.
  
  
• Marrazzo, Jeanne MD, MPH Training Faculty Dr. Marrazzo’s current research is centered in several areas: molecular epidemiology of bacterial vaginosis (BV) and management strategies to prevent BV recurrence; the epidemiology of sexually transmitted diseases (STD), cervical neoplasia and BV in women who report sex with women (WSW); and clinical and epidemiologic aspects of genital chlamydial infections and cervicitis. The major objectives of work related to C. trachomatis are to assess innovative projects to screen and treat asymptomatic men and their female partners, and to define epidemiology among Native Americans/Alaska Natives. Finally, we are studying the etiology and natural history of cervicitis among women presenting to the Seattle STD Clinic.
  
  
• Williams, Michelle, Sc.D Training Faculty Dr. Williams is Professor of Epidemiology and Co-Director of the Center for Perinatal Studies at Swedish Medical Center. Dr. Williams’ current research and teaching interests focus on perinatal epidemiology. Her research has spanned a wide range of topics including genetic and non-genetic risk factors of preterm delivery, abprutio placentae, gestational diabetes mellitus, and preeclampsia. Dr. Williams is Principal Investigator on current projects related to the nutritional, genetic, and environmental epidemiology of preeclampsia, placental abruption, preterm delivery and gestational diabetes mellitus. She teaches the Epidemiology of Maternal and Child Health Problems as part of the core Epidemiology and Maternal & Child Health curriculum (EPI 521) annually. Her past and current research is reflective of a multidisciplinary research approach that integrates basic science, clinical medicine and epidemiologic methods in studies of adverse reproductive outcomes. Since 1995, she has been Director of the Multidisciplinary International Research Training Program.
  

• Community-Based Public Health Preceptorships: These preceptorships are arranged individually, matching the trainees’ career goals and interests with those of the preceptors, to transfer practical skills. For example, a trainee can learn to address STD/HIV hypotheses of public health importance through analysis of data derived from state or county-level STD or HIV morbidity reports and clinical databases, with Group Health Cooperative data, or with Program for Appropriate Technology in Health (PATH), via preceptorships with resource faculty; and can participate in community-based HIV prevention measures with Drs. Golden, Wood, or Buskin.
  
  
• CDC Public Health STD Fellowships: This CDC program, administered by Association for Prevention Teaching and Research, provides a one-year fellowship at the CDC Division of STD Prevention to work with an established CDC STD investigator in areas such as STD epidemiology, STD surveillance, and Behavioral Intervention. The current program, open to both MD and PhD trainees, will accept two trainees annually from a national competition.